The Effectiveness of Fork-Mashable Dishes in Managing Older Patients with Mastication and Swallowing Impairments.

BACKGROUND

The optimal textural properties and therapeutic effects of fork-Mashable dishes for hospitalized older patients with oropharyngeal dysphagia (OD) have not been adequately defined.

OBJECTIVES

This study aimed to (a) quantify the textural properties of six fork-Mashable dishes (British Dietetic Association (BDA) texture E; International Dysphagia Diet Standardization Initiative (IDDSI) level 6), (b) assess the impact of oral processing on texture, and (c) evaluate their safety and efficacy in older patients with OD.

MATERIALS AND METHODS

Twenty patients (85 ± 4.51 years) consumed six 30 g dishes. Oral processing was analyzed using surface electromyography (EMG), texture was measured pre- and post-oral processing, and swallowing safety was assessed using the volume-viscosity swallowing test (V-VST).

RESULTS

Although all the dishes met the BDA E/IDDSI 6 descriptors, significant differences were found in both safety (ranging from 50-100%, < 0.05, for four dishes vs. thin liquids) and efficacy outcomes (oral residues 60-100%; pharyngeal residues 20-70%; < 0.05 for all dishes vs. liquids and French and zucchini omelets vs. 250 mPa·s). Textural characteristics showed wide variability. Oral processing reduced MF but increased adhesiveness, except for in French omelet and pollock fish. The patients required 29-31 mastication cycles over 21-28 s. The post-oral texture also varied significantly across dishes.

CONCLUSIONS

The therapeutic effect of our diets was independent of the BDA or IDDSI levels, with great variations in safety and swallowing efficacy. Textural properties, oral processing behavior, and individual patient responses played decisive roles. Variations in maximum force and adhesiveness during oral processing were crucial for the therapeutic effect, as indicated by the principal component analysis (PCA) correlation.